There are many benefits to bariatric surgery, including improved health and extreme weight loss, of course. However, with extreme weight loss does come excess skin, or loose skin that has lost its elasticity. Loose skin can make everyday life harder and more painful. The body areas that seem to be the most problematic are around the abdomen (pannus), back, breast, arms (bat wings), and legs. Occasionally patients will develop redundant skin around the neck. Fortunately, there is surgery to remove this extra tissue and improve cosmesis and functionality.
Why You Have Excess Skin
When patients lose a significant amount of weight, they are likely to have excess skin. Think of a balloon. First, the rubber is tight and elastic, but after several days of being filled with air, that rubber becomes its elasticity and becomes loose when deflated.
The same is true for your skin. Although our skin has a natural elasticity, that elasticity is lost after being stretched for several years.
Yet, it is essential to note that everyone is different. Some patients may lose a significant amount of weight and have less loose skin, while others may have more. Of course, other factors will determine the amount of loose skin that remains, such as your genetics, age, and how long you were overweight, among other factors.
Pros of Excess Skin Surgery
1. Less Pain
Carrying around pounds of excess skin in the front of the abdomen (pannus) can become painful over time. The extra weight can cause back pain. After excess skin removal surgery, most patients will experience less stress on the back when the extra weight is lost in the front.
2. Improved Mobility
The most common area for excess skin is in the abdominal/stomach region as most of your weight was likely carried here, and the abdominal skin has a large capacity to stretch. Once you lose the weight, this results in "the apron"—loose hanging abdominal skin. This can make it hard to walk and perform everyday activities.
3. Better Hygiene
Patients who have a lot of excess skin, especially around the abdomen, may find it hard to clean within the creases. This can cause a build-up of bacteria and result in rashes and even infections, not to mention odor.
4. More Self Confidence
When patients begin their weight loss journey, they are often very excited about the prospect of losing a significant amount of weight and achieving their "dream body". Although we discuss excess skin as a consequence of the surgery, many patients do not realize how much it can affect their confidence. By removing this excess skin, patients will feel more confident in their bodies and are likely to become more engaged in social activities.
Cons of Excess Skin Surgery
1. It's Expensive
Excess skin surgery can be pricey when done as a "cosmetic procedure." Fortunately, we are seeing more and more insurance companies covering the removal of the excess abdominal skin (abdominoplasty/panniculectomy) when medically necessary (i.e., the skin causes pain or rashes, causing mobility concerns and functional deficits). Unfortunately, we never see the operation on the arms, legs, or other areas of the body covered and will need to be done as a "cosmetic" procedure.
2. Surgical Risks
Like all surgical procedures, excess skin surgery does come with risks, the most notable one being the risk of wound-related complications such as infections, seromas, or hematomas. Because the surgeon makes a large incision to remove the excess skin, the blood supply is compromised and may result in poor healing and potential wound breakdown. Fortunately, all of this is treatable.
3. Recovery is Painful
As mentioned above, the surgeon must make a large incision to remove the excess skin. This means a more prolonged and possibly more painful recovery.
Deciding If Excess Skin Surgery is for You
Excess skin removal surgery can significantly improve an individual's life by reducing pain and increasing confidence and mobility. Although some of the risks/cons seem scary, I've never met a patient that regretted their decision to have these procedures. With that said, we encourage you to discuss this procedure with your bariatric or plastic surgeon. This procedure can be costly, yet we guarantee that the removal of your loose skin will significantly improve your self-esteem and quality of life.